On famine fever and some of the other cognate forms of typhus, a lect

Google

This is a digital copy of a book that was preserved for generations on library shelves before it was carefully scanned by Google as part of a project

to make the world's books discoverable online.

It has survived long enough for the copyright to expire and the book to enter the public domain. A public domain book is one that was never subject

to copyright or whose legal copyright term has expired. Whether a book is in the public domain may vary country to country. Public domain books

are our gateways to the past, representing a wealth of history, culture and knowledge that's often difficult to discover.

Marks, notations and other maiginalia present in the original volume will appear in this file - a reminder of this book's long journey from the

publisher to a library and finally to you.

Usage guidelines

Google is proud to partner with libraries to digitize public domain materials and make them widely accessible. Public domain books belong to the
public and we are merely their custodians. Nevertheless, this work is expensive, so in order to keep providing tliis resource, we liave taken steps to
prevent abuse by commercial parties, including placing technical restrictions on automated querying.
We also ask that you:

+ Make non-commercial use of the files We designed Google Book Search for use by individuals, and we request that you use these files for
personal, non-commercial purposes.

+ Refrain fivm automated querying Do not send automated queries of any sort to Google's system: If you are conducting research on machine
translation, optical character recognition or other areas where access to a large amount of text is helpful, please contact us. We encourage the
use of public domain materials for these purposes and may be able to help.

+ Maintain attributionTht GoogXt "watermark" you see on each file is essential for in forming people about this project and helping them find
additional materials through Google Book Search. Please do not remove it.

+ Keep it legal Whatever your use, remember that you are responsible for ensuring that what you are doing is legal. Do not assume that just
because we believe a book is in the public domain for users in the United States, that the work is also in the public domain for users in other
countries. Whether a book is still in copyright varies from country to country, and we can't offer guidance on whether any specific use of
any specific book is allowed. Please do not assume that a book's appearance in Google Book Search means it can be used in any manner
anywhere in the world. Copyright infringement liabili^ can be quite severe.

About Google Book Search

Google's mission is to organize the world's information and to make it universally accessible and useful. Google Book Search helps readers
discover the world's books while helping authors and publishers reach new audiences. You can search through the full text of this book on the web

at |http: //books .google .com/I

ON

FAMINE FEVER

AND

SOME OF THE OTHER COGNATE FORMS

OF

TYPHUS.

JL LECTURE

HELD FOR THB BENEFIT OF THE 8UFFSREUS IN EAST -PRUSSIA

PEBSUABr 9. 1868

BY

RUDOLF VIRCHOW

PROFESSOR IN THE UNIVERSITY OF BERLIN.

.1

WILLIAMS AND NORGATE,

14, HBNIUBTTA STRBBT, COVENT GARDEN, LONDON,

AND

20, SOUTH FUBDEKICK STBBBT, BDINBDBGH.

1868.

/S7. ^. /^.

Iwenty years have passed since last that form clad in
terrors — famine fever — appeared among us. In vain
do we seek to deny its presence now in one of our Ger-
man Provinces. Behold it! That dual-nature in which
seem to unite the two most terrible scourges of man-
kind, famine and disease! It is no longer the pauper
inhabitants of villages and small towns merely, that are
exposed to its baleful influences; its empoisoned breath
has already touched others in a higher station - wit-
ness the doctors and nurses who have fallen a sacrifice
to their devotion.

And still science is reproached with taking no cogni-
zance of famine fever! It is for science to rebut this
charge. Wherefore let it be our task this day to vin-
dicate the truth and throw such light on it that to
us at least no blame may attach.

But does science gainsay the connection between
famine and typhus? It would be hard to attempt to
gainsay a thing for which since thousands of years the
history of mankind has ever and again supplied new
examples. I do not mean by this the so-called Uni-
versal History as it is mostly taught in schools, and of
which a French Admiral lately said, it was little else
but a story of wars and treaties! Fortunately that is
not the opinion held in Germany, England and Ame-

1

— 2 —

rica. And after having repeatedly heard, even from the
mouths of government officials, that the Prussian school-
master bore his full share in the victories on the Bohe-
mian battlefields, it is not asserting too much when I
say, that the history of warfare is merely the external
history of peoples. Their internal history is made up from
very different sources. On the one hand it notes the
glorious victories of civilization, the progress of the hu-
man mind in knowledge — that we call the history of
culture; on the other, it preserves the remembrance of
the ever new impediments in the path of life, of the
painful sufferings of humanity^ — that is the history of
medicine, known I grant but by few, though not there-
fore a less instructive branch of general history.

In our present enquiry we must follow up three
courses of investigation; for from the terrors of famine
and pestilence, the third, — war . — is never far off.
Like three brethern, — the apocalyptic riders — they go
forth '^to kill with the sword, with hunger, and with
death". Camp fever is a mate in all respects worthy
of famine fever! The one cannot be disjoined from the
other in a scientific enquiry. Within the memories of
many still living they have alwfiys been thought of as
combined.

Thucydides speaking of the Athenians when they
were visited by the great pestilence, which swept away
Pericles and numberless others besides, during the se-
cond Peloponesian War (B. C. 430 — 25) says: — ''In
those times they remembered themselves of the following
saying, which, as the oldest inhabitants gave out, had
been foretold a long while ago: Come will a Doric
War, and hand in hand with it the plague. Now", he

- 3 —

goes on, "people contend that in this saying of the An-
cients not hunger (limos) was meant, but plague (loi-
mos).'* An idle contest, for they, dearth and famine,
prevailed as well as pestilence. The popular saw of the
Middle Ages was more correct. It ran thus:
War, pestilence and sarcity.
D'ye hear o' the one, soon the other you sec.

And there was opportunity enough in the Middle
Ages of testing the correctness of this rhyme; for, for
many a century, the history of wars and sufferings alone
chronicled the fates of nations. We call them the dark
ages, because the history of culture found little or nothing
for her pen.

As the light of knowledge grew brighter, the in-
tervals between the wars became longer. The prolonged
terms of peace quickened the intercourse between nations,
and promoted agriculture, industry, art and science.
Notwithstanding the increasing dearness of corn, famine
became rarer, and at last so rare that even the old
proverbs dropped into disuse. —

The famine in Upper- Silesia (1847 — 48) was the
first in Germany for more than 70 years, the last great
famine fever having raged in the years 1770 — 72. Camp
fever had not re-appeared since the great Napoleonic cam-
paigns, when, of a sudden before Sebastopol in 1855 — 56
it broke forth again with all its ancient virulence.
Amongst the other rich blessings which a long and
prosperous peace had bestowed on nations, was also that
of a higher condition of health. Two generations had
passed, and pale famine had not reared her head on Ger-
man soil. Was it astonishing that even in science the
old knowledge once possessed had fallen into abeyance ?

_ 4 —

In the course of this long period medicine had made
gigantic strides. Whole new territories of science had
been annexed; pathological anatomy had come into being,
teaching to note the changes in the internal organs, with
a far greater closeness and precision. New methods of
examination at sickbeds were introduced, rendering the
diagnoses more nicely discriminative. New names for
diseases came into vogue; well-known terms, hitherto
bearing a general and vague meaning, were sharply de-
fined, and restricted to one idea, while others which had
a limited signification were widened and generalized.

Such had been the case with the word typhus —
a very old one. We find it in the writings of the oldest
Greek Physician which have come down to us — in
Hippocrates who was living during the time of the
Athenian plague. It literally means fog or vapour, and
figuratively from that, a clouding of the mind, insensi-
bility; likewise a condition of the brain in which its
action is hindered or impeded, as when the conscious-
ness is obscured and dimmed. We often say our head
is so dull and heavy — the thinking powers obfuscated.
It used to be supposed this dulness, or torpidity of the
brain was accompanied with fever, or was a necessary
condition of the same. Anyhow the word upon the whole
was little in use in ancient times and still less in the
middle ages. In modern times, however, it has been
more frequently employed, though it first came into ge-
neral use during the great Napoleonic wars when it was
chiefly applied to war typhus or camp fever. Which
disappearing with the years 1815 — 16, the name was
retained and applied to other fevers, otherwise known
as mucuous, nervous and such like. These were likewise

— 5 —

described as a strong fever accompanied with obfusca-
tion of the brain, and great relaxation of the nervous
system. To avoid confusion permit me for the present
to call this manner of attack in contradistinction to the
above, home -fever (Friedenstyphus).

About the last year of the war 1813 two French-
men, Petit and Serres, discovered that the abdominal
organs, namely the intestinal glands suffered material
changes under this fever. Not long afterwards in
Germany, where similar observations had been made
in the last century, the fact of these changes in the
organs was confirmed, chiefly by von Pommer und
Schoenlein, and thereby the conviction gained that
this phase of the disease was essentially the enteric ty-
phus (Typhus abdominalis, Heotyphus). It lasted to
be sure some 20 — 30 years, before this conviction was
generally accepted. At present it is a common scien-
tific acquisition.

What meanwhile had been done for camp and fa-
mine fever? For many a year no apportunity either in
Germany or France offered for more exact investiga-
tion, and in England where it did exist, it was not ob-
served with due attention. However the plague of 1848
in Upper-Silesia, the fever in the Crimean armies in 1856
furnished the experience (which had meanwhile been
made in England) that those changes in the abdominal
organs which were the unfailing accompaniments of home-
typhus did not appear. Thus was the fact established
of there being two different sorts of typhus^ the one of
which, our common typhus, having nothing in common
with either camp or famine fever, while the other cer-
tainly did present points of connexion. In a former

— 6 —

work I bare called this second simple typhus, in con-
tradistinction to that enteric tjphns known by its com-
plicated changes in the intestinal organs.

Now the question arises, ^are camp feyer and fa-
mine ferer one and the same disease? The difficulty
of answering this question has been considerably aggra-
Tated by the circumstance, that for a loug time fortu-
nately, no proper comparative observations on these two
forms could be made. Later when the opportunity did
occur, it appeared that the cases generally stated as fei-
mine fever were again divisible into two different groups,
oaly one of which it seemed could be classed along with
camp fever. Let us first consider this one

One Girolamo Fracastoro, a doctor of Verona,
was the first to give a circumstantial description of a
pestilential fever which broke out in Upper-Italy in 1505
after a failure of the crops. From a peculiar eruption
which came out consisting of red flee-bite-looking marks
(morbus peticularis or pedicularis) the people gave it
the name of the ^flee-bite fever", which is the origin
of the term Petechial fever or Petechial typhus. In
Germany the term ^spotted fever" was usually employed.
In contradistinction to the typhus abdominalis the name
exanthematio also came into use. In fact the eruption is
frequently so excessive that inexperienced persons, nay
unkilful medical men have mistaken this illness for
measles.

The connexion between spotted fever and dearth was
acknowledged from the very beginning, though from con-
siderations bearing upon atmospheric changes and the al-
titude of the stars, to which even in those days a still
greater significance was attached in the opinion of the

— 7 —

learned, it never came into sufficient prominence. The
terrible plague in the years 1770 — 72 which desolated
the whole of the North and a part of South Germany
and France, left no further doubt about the connexion,
between the same with dearth and failure of the crops.
Those were years of great calamity. Summer cold,
winter with hardly any great frost; for the most part
dull damp weather with such floods of rain in all low-
lying districts that unheard inundations were the se-
quence. The following are the numbers of rainy days
in the respective years from 17G8 — 1772, viz:

1768 .

. . . 177

1769 . .

, . . 201

1770 . .

, . . 208

1771 . ,

. . . 175

1772 . .

. . 166,

accompanied by an invariably low state of the mer-
cury, continuous westwind and the light of day almost
constantly obscured by trains of flying grey clouds. In
the middle valley of the Elbe they reckoned in 1769
nine, in 1770 only five and in 1771 ten quite bright
days. On the 30*** of May the thermometer reached
only 4°, and on July 12 a heavy fall of snow came
down on the Hundsruck. The foremost consequence
was a total failure of the harvest in the year 1770. The
scarcity of corn soon increased to all the terrors of a
true famine, more especially in the Altmark, Eichsfeld,
throughout all Bohemia and Moravia, Hannover, the Rhe-
nish Provinces and France. Arand, the head physi-
cian in the town of Heiligenstadt in the Eichsfeld, has left
us a very lively description of his impressions of whicli
the following is an extract:

-- 8 —

*Never shall I think but with horror of the misery
of our country, of the afflicting distressing and cruel
condition of our fellow countrymen. Those who sickened,
lay without hope. Hay, second crop, garden fruits, vege-
tables and grain were spoiled and rotting. The farmer
beheld his labours which had cost him the sweat of his
brow perish utterly and miserably. Floods of calamity

— the most dreadful of them famine — rolled over their
heads. You could see the grain on the stalk just sprouting

— but unseasonably, and only partially dried by the
heat of the stove they were taken and consumed by the
famished poor to appease the cravings of hunger. The
scant remains were garnered damp; the chopped straw
could scarcely be used at all for fodder, while it was
impossible to save the thrashed grain from rotting. The
former was dangerous for the cattle, the latter for men.

The consequence of three such successive years of
failure of the harvest was an incredible dearth, incon-
ceivable alike to the oldest people as to their descen-
dents. The most terrible distress, in short the extremest
famine oppressed the poor. Trade came to a still-
stand. All the channels of gain were closed. The com-
plete want of money forbade the enjoyment of bread.
A sixpenny loaf could' not suffice for one person, much
less for a whole family, for there was no nourishment
whatever in the dear (lieben) bread. It was no wonder
then that these wretched creatures, in order to support
their miserable existence, should take to food fit for cattle,
and against nature. I mean for instance, grass, thistles,
and unwholesome sorts of cabbage, bran-porridge, roasted
rye-gras, vetches and other grain fruits made hot. Nay

— 9 —

the distress at length compelled them to resort to that
fare on which foxes feed.

All that was nnaccustomed and abnormal nourish-
ment, and had a material influence on what we call
the fever,'^'*

But the fever which spread far and wide, and
which by contagion passed to the better classes, was
described in pretty simUar terms by aU observers, under
the name of spotted or putrid fever.

Ireland likewise was visited in the year 1771 with
the epidemy, spotted fever. I admit that this fact has
only recently excited our attention, only indeed since
we got to know that it constituted the heading to one
of the chapters of human misery. Since now almost two
hundred years Ireland may be considered as the prw,"
cipal seat of the famine fever. It is not too much to
say, that as Egypt was from the plague, so has Ireland
ever since 1708 been desolated with ever new visitations
of this most malignant of epidemics — the typhus fever
(Petechial-Typhus). No other country in the world can
be even distantly compared with it in this respect. Public
attention and solicitude were chiefly directed to this point
since the plague of 1817 — 19 when 44,000 individuals
perished, and the eighth part of the entire Irish po-
pulation sickened. At that time several cases occurred
also in Edinburgh and London, since when new epide-
mics have followed in quick succession , among which
the inconceivably virulent one of the years 1846 — 1848
calls for notice. It first appeared after a wide -spread
failure of the potato crop. The total of those who were
seized throughout the whole country was calculated at
more than a million, 40,000 being set down to Dublin

— 10 —

alone. The poor Irishmen left their green island in crowd.
But whither they went, the typhus went with them.
Above 300,000 had been seized in England, chiefly in
Liverpool where 10,000 died. In 1847 75,000 Irishmen
emigrated to Canada. Wellnigh 10,000 of them perished
partly on the way out, partly in quarantine ; but all could
not prevent its being brought into several American
towns. Simultaneously with this Irish plague, although
in no immediate connexion with it, famine fever showed
itself in Flanders and Upper - Silesia spreading as an
epidemy. Since 1836 the population of Flanders had
not been in so prosperous a condition, owing to the
factories having supplanted the hand -looms; and 1845
witnessed the complete victory of machine labour over
that of the hand. Close upon this came in 1846 the
total loss of the potato crops, and but a very indifferent
grain-harvest. The distress became so great that in many
places the inhabitants could only find turnip -parings,
dandelions, cabbage -leaves, carrots, diseased potatoes,
sometimes a little brown bread to eat. Nay many fa-
milies could not even procure themselves those luxuries
every day. Here the epidemy broke out, and the sum-
ming up at the close of the year 1847 showed that the
population of West-Flanders in consequence of the nu-
merous cases of death was reduced to the standard of

1841, and the population of East -Flanders to that of

1842. Of 60,377 who were seized 11,900 died, i. e-
almost 20 per cent.

The potato disease had come to Upper -Silesia in
1845, and repeated its visit the following year, when the
distress became so great that the circles were forced
to make loans to enable them to distribute flour to the

— 11 —

poor. The annexation of the free state Cracow by Austria
and the consequent imposition of duty blighted all of a
sudden the hitherto flourishing linen and woollen trade
of the small towns. The poor people had to sell their
cattle, then the store of sourkraut the favourite food of
the lower classes likewise came to an end, and nothing
was left but diseased potatoes, clover and scarcely eatable
fruit. The opening of the summer excited great hopes,
but copious falls of rain and inundations came later, the
potato disease broke out anew, in short the harvest was
a complete failure. The fever now broke out. When
I published my report in the summer of 1848, the fol-
lowing was the picture I drew: "A desolating epidemy
and a terrible famine are raging at the same time amongst
an impoverished, ignorant and dispirited people. In the
canton of Pless died in one year 10 per cent of the po-
pulation; six and a half of starvation and fever while
the official lists tell us of I^iq of downright starvation
alone. In the district of Bybnik, 14.3 per cent of the
inhabitants fell sick in eight months of the fever, of whom
20.46 per cent died, and it was officially corroborated
that a third part of the population had to be wholly
maintained for six months. In the beginning of 1848
the two districts reckoned as many as 3 per cent of
orphans. Thirty-three doctors as many priests and bro-
thers of Charity and other helps and assistants were
seized and not a few of them paid their charity with
their lives." The total number of those swept away by
famine and disease in the province is computed at 20,000.
In all these epidemics the number of which we could
easily swell, it was the spotted fever with its well-known
symptoms that decimated, nay more than decimated the

— 12 —

people. It was, therefore, a natural connexion of ideas
that the term &mine fever, or famine typhus (typhus
famelicus) or famine plague should repeatedly come to
be substituted in learned treatises or by the people for
that of petechial typhus, exanthematic typhus and spot-
ted fever.

Another peculiarity, however, had meanwhile at-
tracted the attention of medical men. In 1843 Hen-
derson an Edinburgh doctor publicly uttered the con-
viction which till then had silently been gaining ground
viz. that besides the enteric typhus and the spotted fe-
ver there was a third typhoid disease differing from the
enteric fever in the absence of all abdominal changes, «
from the spotted fever in the absence of the eruption,
itself being characterised by the peculiarity of sudden
relapses after apparent recovery. It received the name
of relapsing fever (Typhus recurrens).

Historical researches have proved that the malady
is not by any means a new one, and although it is to
be regarded as doubtful whether this form of sickness
was known to the ancients and in the middle ages, it
may be assumed as a fact, that is has afflicted Ireland
epidemically at intervals since 1739. However that may
be, it is rarer by far than the other forms. Beyond and
excepting Great Britain and Ireland only one great epi-
demy in Russia 1864 — 65 and several less considerable
ones in Belgium 1865 — 67 have been as yet described.
Since 1855 it has never again reappeared in England
or Scotland.

Till now .it has never been made perfectly clear
what the relations between spotted fever and relapsing
fever are. It would seem from the observations al-

— 13 —

ready made that many epidemies at the outset inclined
principally to relapsing -fever, yielding at a later period
to spotted fever, and in proportion as the epidemy
lasts and increases in strength, the relapsing fever loses
ground leaving spotted fever to stand alone. Relap-
sing fever being a milder form of disease, the supposi-
tion is not far fetched that it is merely a less malignant
degree of the same fever. Trustworthy observers oppose
to this the result of their observations viz. that contagion
from relapsing fever, only produces relapsing fever, and
spotted fever only itself again.

This excessively nice question is of subordinate im-
portance for us at present, for it changes in little or
nothing its relative position to famine. Murchison
who lays a peculiar stress on the distinction between
the two says expressly: ^Epidemies of relapsing fever
come usually with the spotted fever epidemy, always
appearing under the influences of want and hunger."

Let us now cast a glance at the war fever. What
is comprehended under this name, may according to pe-
culiar circumstance be subdivided into several groups.
First in the category comes the dreaded camp fever
(Typhus castrensis). In the earliest times already they
were aware of this danger which frequently brought
worse losses in their armies than the bloodiest engage-
ments. It may remain an open question whether the
plague which broke out in the naval encampment of
the Greeks before Troy assumed just this form. It is
very much more probable that it was that malignant
camp fever which in the year 395 B. C. raged among
the Carthagenians when they were besieging Syracuse
under Hamilcar, and of which Diodorus has left us

— 14 —

a description. However the plague which broke out in
the army of Ferdinand the Catholic, when laying
siege to the Moors in Granada in 1 490 is now regarded
as the first undoubted epidemy of putrid fever; it cut
off 17,000 men. The French host suffered still severer
losses in 1528 in the camp before Naples, about the
same period to which Fracastoro's classical description
of spotted fever in Upper -Italy belongs. The French
policy of intervention in Italian affairs which for so many
centuries has troubled the fate of that lovely country,
met at that time with its first decided check to which
camp fever did not a little contribute. Thirty thousand
French succumbed before the pestilence in sight of Na-
ples, amongst whom their leader Lautrec.

It is uncalled for to pursue the history of camp
fever through the long series of the wars of the middle
ages and modern times. Let us conclude whith a glance
at the latest camp fever — that before Sebastopol. Ty-
phus first appeared among the Allies in the December
of 1854, after its having already taken some dimensions
in the Russian army. It very soon found its way to
Constantinople and into all the hospitals erected there.
In the course of the following summer it almost entirely
disappeared; then again in the December of 1855 re-
appeared with greater virulence spreading this time not
only to Constantinople, but likewise to the hospitals of
Marseilles, Toulon, Avignon, nay even to Paris. Odessa,
Varna and the Turkish army in Asia Minor were seized.
Jacquot, a French army doctor, calculates that in this
second epoch of the French army alone, which was
120,000 strong, 10 per cent fell sick. The mortality,
however, among the cases rose to 50 per cent.

— 15 —

The Crimean war exemplifies to us that it is not
the besiegers alone who are exposed to the typhus but
the besieged as well. There are fortress fevers of a more
pestilential sort than are the camp fevers. The plague
of Thucydides was such a one. It was engendered
within the walls of Athens when the Attic peasantry
crowded into the town from all sides seeking protection
from the attacks of the Spartans. During the Napo-
leonic wars there were few of the larger fortresses in
which during the state of siege the typhus did not rage.
•Saragossa, Mayence, Gaeta furnish us examples. Tor-
gau was the scene of one of the mo3t desolating epi-
demics in 1813. In this little town of 5100 inhabitants,
8000 horses and 35,000 men were cooped up together;
in the time from the first of September 1813 to the
surrender of the place the tenth January 1814, 20,435
men died in it, 19,757 being soldiers and 680 burghers.
The total of mortality among the citizens in the time
from January 1»* 1813 till end of April 1814, within
16 months amounted to 1 122, that is to say, to almost a
fourth. The same year in Danzig two thirds of the
French garrison, and a third part of the population fell
a prey to diseases.

But later times have increased the number of typhus
forms by giving us the knowledgiB of a third sort of war
typhus of which the ancients were ignorant, hospital fever
(Typhus nosocomialis). It was doubtless a great step in
human progress, when war-hospitals were begun to be
built, wherein to lodge and nurse wounded and sick sol-
diers. However there is no human arrangement but brings
some form of suffering along with it, and every onward
step is taken amid errors and mistakes. Thus the war-

— 16 —

hospitals turned to new sources of the typhus; very
frequently real hotbeds of contagion, sending forth far
and near their pestilential breath. After the victories
of 1813 our own capital Berlin was taught to know what
hospital fever is in its worst form.

Let us in conclusion touch upon ship fever (Ty-
phus navalis), once the scourge of the navy, chiefly of
the prison- ships. Fortunately it has diminished in pro-
portion as good food and cleanliness have become the
rule in war ships. We must hope that it will soon be
unknown in emigrant vessels.

In the majority of cases camp fever is undoubted
spotted fever. In some epidemies only, viz. in those in
fortresses it was clearly a question of enteric typhus.
As a general rule we can always assume that camp and
famine fever may be regarded from the same point of
view. But if this is the case, the question suggests
itself: viz. what resemblance obtains between the in-
cidents of war and famine so as to account for the si-
milarity of efiect? —

This brings us to the question of the grand causes
of typhus which it is all the more encouraging to treat
here as each man may choose for himself instructive
points of view. It is at the same time of general value
in so far as it offers an excellent example of how clearly
and sharply defined modern science stands out as con-
trasted with the more or less mystic mode of thought
of the ancients.

The old world referred every unusual appearance
to special and divine intervention. Did they believe in
many gods, it was then one of those who sent the
scourge. Did they believe in one God, it was presumed

^ 17 —

to be a dispensation from him. Herewith all research,
properly so-called, was at an end. For would it not
be audacious for the finite spirit of a inortal to divine
some reason for a divine act? However terrible a burden
the plagues were to bear which the Deity sent, there
was no alternative but to submit. At most they were
suffered to meditate on their own sinfulness and hope
by atonement for the wrongs committed, to avert the
wrath of God from themselves, and their friends.

To this the nations of the East added their belief in
the stars. Though these were likewise heavenly bodies
raised far above terrestrial vicissitudes, still it was but a
step to invest them with a sort of personality, nay even to
take them for divine emanations fitted out with miraculous
powers. The sun and the Sun- God, the moon and the
Goddess of the moon blended into one. Symbol and idea
were no more two but one.

Notions of this hazy and therefore intangible sort
ruled human thought till far into the Middle Ages. Added
to which, as the circle of the experience of nations
widened, many peculiar views embracing another class
of influences which although within the bounds of na-
ture and possibility, still savoured of the supernatural.
Comets, meteors^ earthquakes and eruptions of burning
mountains, were carefully noted and closely associated
with the outbreaks of pestilential diseases. Thus although
the events were natural they still retained somewhat of
the mystic, the inexplicable about them. And thus also
in addition to the fact of the natural phenomenon re-
mained likewise the power of ascribing the scourges
and afflictions imposed on sinful man to a peculiar and
divine Providence. I need scarcely remind my readers

3

— 18 —

bow popular the u$e of this formula is at the pre-
sent day. —

Amongst the learned likewise, and quite especially
among the chroniclers of great plagues there are eyen
yet not a few who ^first and foremost'" incline to Cdl
back on comets, earthquakes and such like partially un-
explained occurrences, instead of busying themselves with
the investigation of the proximate causes and effects on
and about the persons and circumstances of their patients.
This bent to explain the individual occurrence by the
whole is deeply -rooted in the human mind; the cir-
cumstance that the whole may be dark does not deter
them from considering this as the most preferable me-
thod, being moreover as a rule the least laborious.

Here lies the line of demarcation between ancient
and modern science. Though far be it firom me to po-
sitively wish to dispart isolated occurrences bounded by
time and space from preceeding or simultaneous, though
perhaps distant events. We simply do not start with this
reflection. We are not satisfied with merely marvelling,
at the fact, as for the rest, at something inconceivable,
rather to be considered in relation to the whole than to be
exactly explained. We prefer to make it our task to follow
it up and comprehend it in the time and space in which it
begins and ends. Meteors and vulcanoes, earthquakes and
storms are therefore generally speaking not the starting
point of our investigations into the causes of disease, and
still less so, when the diseases appear in places remote
from those, where oroanes, earthquakes or vulcanoes exer-
cise their power to destroy. The soil on which the sicken-
ing population dwells, the air they breathe, the water
and food they take, their social customs, their domestic

- 19 —

life, their homes, their occupations — those are the points
to be studied and kept in view while seeking to probe
the originating causes of a large proportion of the diseases.

I do not here pretend to say that it is only the pro-
ximate causes that are to be considered, or that appea-
rances in the heavens have no weight in the enquiry into
the origin of sickness. Even now the newspapers are
filled with reports about showers of meteoric stones of
an unusual kind. Storms and earthquakes, to such an
extent, or in such violence and frequency have for long
not so disquieted the northern portion of our globe as
just this winter. Vesuvius is again active. In several
places new islands have arisen from the bosom of the
deep. Is all this and the famine fever in Ostpreussen
a mere accidental coincidence? Are there no signs of
some general connexion? Is not the finger of God plainly
discernible in this? Far be it from me to assert that
chance produces such phenomena with less or more of
regularity. Contrariwise I can here very well conceive
an internal bearing; however with this proviso — we
are not to imagine that the afore-mentioned phenomena
have an immediate influence on the breeding of disease.
One simple consideration gives room for the possibility
of a mediate connexion.

Storms are beyond doubt the results of great in-
equalities in the distribution of heat over the surface of
the earth, and the expression of a straining after equa-
lization in those parts of the atmosphere where inequa-
lities in weight and tension have occurred. Great in-
equalities in the heat of the surface of the earth have
a decided influence on the distribution of the water, on
its evaporation, on the atmospheric precipitates, on the

— 20 —

highwater mark of rivers and lakes, wells and springs.
Again both the state of the air and that of the water
have an effect upon the growth and development of plants,
and through them upon men and animals who derive
from the vegetable kingdom a material part of their
sustenance. They even exercise to a certain extent an
immediate influence on the state of health among men
and animals; for heat and cold, damp and drought may
be in themselves causes of disease. —

In the same manner it cannot be denied that the
terrestrial body itself may be affected by the unequal
distribution of heat. And it is in my opinion a question
of the highest importance to discover whether earth-
quakes and vulcanic eruptions are not a consequence of
the one part of the earth being disproportionately over-
heated and desiccated, others being at the same time in
an equal degree chilled and submerged, thus giving rise
to unequal contractions and expansions in the outer crust
of the earth. We may even go a step further and point
out that the distribution of heat over the surface of the
earth depends on the amount of warmth the latter re-
ceives from the sun, and that this amount may in its
turn again be determined by m^ny other celestial oc-
currences, possibly even by showers of meteoric stones
(asteroids), the extent of the influence of which has as
yet by no means been made clear.

For myself personally the enquiry into the conne-
xion between epidemic diseases, and celestial and ter-
restrial phenomena is not only admissible but positively
necessary. I do not by any means consider it as a mat-
ter of indifference, that just at present, while our country
is afflicted with famine fever, the greater part of those

— 21 —

phenomena known in former years of plague, are again
present, and with more than usual force. But nothing
strikes me as more remarks(ble than this other fact: viz.
that not unfrequently do failure of crops and famine
start up simultaneously in remote parts of the earth.
When in 1770 the famine fever broke out in Germany,
a terrible famine prevailed in East > India the result of
a bad rice harvest. In Bengal, ^the most fruitful land
on which the sun shines^^ the mortality became in con-
sequence so great, that the number of deaths was
reckoned at 3 millions — a third of the entire po-
pulation. While the scarcity in the northern countries
of Europe was a consequence of a succession of cold
wet weather, a continuous drought and heat had killed
vegetation in the Indies.

And is not that very striking? Let us recall like-
wise that the succession of cold wet seasons that have
now brought us distress and disease, were proceeded by
a famine in East -India, to master which neither the
practical genius of the English nation nor her inexhaus-
tible resources sufficed. Again it is quite to the point
that while in Ostpreussen we had scarcity and dearth a
consequence of falls of rain and inundations, in the sub-
tropic countries on the other coast of the Mediterrean,
Morocco, Algiers and Tunis, people were dying by thou-
sands of starvation. That is quite intelligible.

But it is just as intelligible that we cannot meet
such crises with religious observances. A wise and joint
foresight is only practicable by extending the network
of scientific observations. We are proud of being able
to read now every morning in our papers the state of
the weather in a couple of dozen 6f European places.

— 22 — ■"

Oar agricultural society think they do no small service
when, after the respective seasons they can sum up the
weather that a few neighbouring European countries
and North-America have had for seed-time and harvest.
This is but a beginning of what must be. With the
co-operation of meteorology, agriculture, trade and m^»
dicine and with the aid of an increased number of sta-
tions for scientific observation over the whole face of
the earth, such as Alexander von Humboldt has
already instituted for a limited purpose, it will in fu-
ture be possible to descry and avert the coming evils
of starvation and sickness, or at least, when this is not
practicable, to mitigate their effects.

To this view are opposed two others in as far as
typhus is concerned at least. A few who still incline
to the older notion of the celestial origin of plagues,
are disposed to accuse wind and weather as principal
agents. I am far from being inclined to rate their in-
fluence low, as I think I have already shown in my
picture of the typhus in Upper -Silesia. And here I
wish to impress the striking fact, that in simultaneous
cases of dearth in wet and dry regions, only those in
the wet were exposed to famine fever. In Bengal in
1770 this malady was unknown notwithstanding the wide-
spread distress, while in North - Germany it prevailed
everywhere. Now the harvests had failed in India by
reason of heat and drought, and in Europe by reason of
cold and wet. Here then is a point to be noted — weather
alone does not 'produce typhus. Were this the case we
should be very powerless to succour, for who can change
the wind and weather, or protect out-door workers from
their effects? Fortunately there is no '^airt the wind

— 23 —

can blaw", and no weather either which can of them-
selves breed typhus. That they both bear a powerful
part in inducing the conditions favourable to the vivi-
fying of typhous germs, and likewise aid the beginnings
and spread of typhus itself, cannot only not be doubted
but can be deduced from what has already been said.
However it is one thing to aid in creating the conditions
and another being the conditions themselves. This point
has been discussed by me more at length in a former
work. —

Another pretext rests on the contagious qualities
of typhus. They are much exaggerated, though it has
been so far proved that typhus, and more especially
spotted fever, can be contagious and that in a very high
degree. The assumption that spotted fever spreads by
contagion is handy, and this explanation has been freely
made use of. In the times of Thucy did es many held
the opinion the plague had been brought from Egypt
to Athens. Both at the siege of Granada in 1490, and
in 1505 in Upper -Italy, the report was rife that the
plague had come over from Cyprus. In Silesia the epi-
demy of 1848 was suppositiously derived from Galicia,.as
now in Ostpreussen they pretend it has come to them from
Silesia. In Galicia again it was referred back to Poland.
The disposition in England to look for the beginnings
of every new epidemy in Ireland is so strong, that the
spotted fever is simply termed Irish fever. An obser-
ver. Pop ham by name, says: * Typhus pursues the
Irishman to whithersoever he may transplant himself and
his misery." And in fact, he not only carries the dis-
ease again and again across the ocean to the sea ports
of North -America, and to the large commercial and

— 24 —

manufeu^taring districts of England and Scotland, but in
his own country, their fQthy dwellings swarming with
inmates and vice, form an abiding harbour and homestead
for epidemics &om which they are ever ready to issue
forth, to spread death and desolation all around.

Upon such a testimony one would be inclined to be-
lieve that spotted fever, like cholera, the plague, and the
more notable eruptive diseases (small pox, scarlet fever,
measles) with which in so many points it bears a re-
semblance, were bound to certain homes, certain never
varying centres from which from time to time it radiates.
Were this the sole source of the great epidemies the
chief consideration would naturally then be, how to
stem the current of contagion by opportunely debarring
all intercourse between typhous places and their sur*
rounding neighbourhood. -

That however is far from being the state of mat-
ters. In Upper -Silesia where they pointed to Galicia
as the cradle of their calamity, it turned out on closer
enquiry that the fever had been hanging about the pro-
vince to some small extent long before 1848. Further
the disease was not carried beyond a certain territory
even although persons struck with it came as far as
Liegnitz and Berlin. Breslau in constant connexion with
Upper-Silesia remained quite exempt. Not till the year
1856 when the illness assumed a very mild form of epi-
demy in Upper -Silosia did the spotted fever come to
light in Breslau maintaining ground there for several
months. But the experiences of the past are too apt to
be forgetten or perhaps we never get to know them at
all. As long as the history of medicine is indebted for
its increase to voluntary individual contributions, it will

- 25 -

alway remain incomplete, because the greater number
of medical men withhold their observations. And the
Government organization of public sanitary measures
is, with the exception of a few places, so backward
that reliable reports on single districts or periods can-
not be looked for. Hence the oft recurring mistake
of the malady being regarded as something new where
it has already and repeatedly prevailed. Such is the
case with the Province of Ostpreussen. Stray reports
about the presence of this epidemy in that province go
back to the year 1836. In Danzig itself a slight epi-
demy prevailed in 1848. It is here as in the Russian
Baltic Provinces and in Poland from whence accounts
drop in at. intervals.

The narrower we observe, and the closer we inquire,
the fact of the spotted fever being much more prevalent
than is suspected meets greater confirmation. Apart from
those public epidemics, as we may term famine and camp
fever on account of their claim on the general sym-
pathy and aid, there occur numberless detached cases
(so-called sporadic) which are not unfrequently falsely
treated, the medical men themselves not possessing ade-
quate experience in that form of suffering. Since 1848
when the eyes of observation hi&ve been quickened in
Germany, quite isolated cases, or small groups of cases
of exanthematic typhus have been described in spots
far from the abodes of the chief epidemics. Detached
cases were received into the hospitals in Wurzburg in
1855 and in Berlin in 1863. A somewhat larger number
of cases was brought under observation in Leipsic in the
winter of 1853 — 54 which indeed seemed traceable to
the Harz- forest country, and the Erzgebirge. Since

— 26 —

the spring of 1867 there has been again a slight epi-
demy prevailing in Berlin which is not yet extinct. My
observations in my departement of the Charite hospital
have shown me the disease to be in a very high degree
contagious. Many of the patients had obviously brought
their maladies with them from other places having ar-
rived here sick from Stettin, Magdeburg etc. Others again
sickened here without its being possible to establish the
fact of contact with the strangers. They were for the
most part poor inhabitants from the North of the town
(Berlin), the workmen's quarter. About this very time
a violent epidemy, though limited in its extent prevailed
in Yorpommem (Pommerania). It took first the road-
side labourers, but afterwards spread further. At present
the spotted fever is in Vienna.

In many of those milder epidemics, the possibility
of their being first brought in and spread by neighbourly
intercourse so as to form groups of cases cannot for the
present be gainsayed. Investigations in this direction
must for the future be much more exact, as well as the
system of interrogating. I may nevertheless here ad-
duce the authority of such medical men as live in the
so-called typhus districts who express it as their con-
viction that alongside of transmission by contagion, there
is an independent, or figuratively speaking, a spontaneous
origination of the spotted fever ^ as in general there is
thought to be of the enteric fever.

Let us now consider the conditions which favour
the development of the typhus fever, or in the strictest
sense of the word the causes of the disease. We must
first of all call attention to the fact, that through almost
every century one fundamental notion has influenced the

— 27 —

opinioDS of both medical and lay observers relative to
the nature of typhous diseases, viz. that the human body
becomes impregnated with some principle foreign to it
and therefore injurious, which principle represents the
centre point of the malady. The ancients called it
miasma ^^pollution'\ and the condition of the human body
which its reception occasioned infectio "pollution". In
the large manual of pathology and therapeutics which
I in conjunction with some eminent clinical authorities
in Germany recently published, I restored this con-
ception of the thing by classing them all in the cor-
responding section under the name of infectious dis^
eases (Infectionskrankheiten).

But what is now this impure principle? And
whence comes it? It used to be the custom to derive
it from a sort of foulness or corruption now in the air,
now in the water qr in the food. Hence the term pu-
trid fever which has sa frequently be given as the ge-
neric title to the whole group of fevers here treated. The.
greatest stress was laid on the corruption of the air in
this system. Herein a partial attempt is at least ob-
servable to discover single new and nearer references
between typhus and some widespread diseased conditions
of animals and plants. For instance in Posnania the si-
multaneous appearance of the cattle plague was thought
of the last importance. This simultaneousness, however,
holds good for only certain epidemics, not even for all in
Sclavonic countries, and not at all for Ireland. More
to the point is the question of its affinity with certain
diseases in the vegetable kingdom which of late years
have attained to such prominence, as the grape disease,
or more especially the potato disease. Botkin in Pe-

— 28 —

tersburg absolutely contests for the relapsing fever the
possibility of its being engendered by the use of dis-
eased potatoes.

The history of the potato contains certainly many
bearings on the question that here occupies us. But
the first great epidemy of the potato -disease does not
fall till the year 1845, and although we cannot deny that
just the great scarcity of the years 1846 — 48, and con-
ditioned by it, the outbreaks of famine fever were to a
very considerable extent occasioned by the failure and
disease of the potato, still this does not hold good for
all epidemics of spotted fever since 1845, and at all
events not for those before 1845. Nay the spotted fever
existed in Europa before a potato at all was to be seen
on this side of the ocean. —

The first potatoes were introduced into Spain in
1565 by Hawkins from South - America, from whence
they found their way into Italy in 1580. Here they
received the name of Tartoffi or Tartoffiili from which
our German word (Kartofiel) is said to be deriyed. Their
introduction into England was without any reference to
the above. Sir Walter Raleigh brought seed with
him from Virginia in 1584 rearing them on his pro-
perty Younghall near Cork. Thus was bestowed on Ire-
land this root of which it is justly said it has been at
once her blessing and her bane. A new importation
reached England through Francis Drake in 1585.
But a yery long time passed before the potato became
even a common food. For many years they were me-
rely a dainty for the highborn, and the people so ob-
stinately refused to cultivate them, that the government
thought it a duty from time to time to use coercion.

— 29 —

It is believed the first potatoes in Germany were cul-
tivated in Bieberau in the Odenwald 1 648. They did not
reach Prussia till 1720; the prejudice which existed
against them however, first gave way under the pressure
of the great dearth of 1770 — 72. Seventeen hundred and
seventy is generally considered as the year they were
brought to France.

This short sketch will have been sufficient to prove
that the potato and the typhus have no immediate con-
nexion, though of mediate much. In less than a cen-
tury this vegetable has mightily affected not only agri-
culture but the whole of social life in Europe. Its com-
paratively great productiveness renders it possible to
maintain a far denser population on a certain extent of
ground than could be done by the cultivation of corn
alone. The potato has become, so to say, the corner stone
of the existence of the ^^small man" in rural districts.
The workmen and artisans of small towns even find in
it a comparatively abundant source of nourishment. For
a long time therefore the introduction of the potato ap-
peared to be only a benefit, nay the probability was
canvassed of never more knowing what famine was.

But the reverse of this innovation was too sad. We
have long been aware that the potato but very insuf-
ficiently supplies the body with all the aliment requi-
site for its growth and maintenance. Excellent as it
is taken along with a due proportion of animal food
or fatty matter, its value as a main aliment is doubt-
ful, especially for a labouring population who are re-
stricted to the potato and its product — alcohol. It
is not enough that such a people's muscular power gra-
dually diminishes, that they become weakened in consti«

— 30 —

tution, and thereby contract an increased disposition to
disease , but — a single failwre of (he potato crop or at
most a second^ witnesses such a people on the threshold of
starvation.

That was the case in Flanders and Upper -Silesia,
that is the case in Ireland and Ostpreussen. Properly
speaking these populations are alway standing at the
gates of famine — let distress come and they are help-
less. The so-called "practical men" then say — the peo-
ple are accustomed to it, matters are not so bad for in-
deed they have never been otherwise. In Silesia in 1848
they were even apprehensive the people should be spoiled
by giving them flour! And if they got none, why they
had — to starve! What an alternative! It is indeed
^so bad'''* with these people that every intelligent and
practical man should make it his task to persuade them
to grow something else besides potatoes. Such a state,
of matters must and dare not be given as a reason for
not succouring them in times of scarcity, or of giving
them but lukewarm aid. It ought rather to form a
weighty and powerful motive for rendering them assi-
stance, and giving them a vigorous ^lift'\ before distress
again overtakes them.

Potatoes are doubtless in intimate connexion with
a state of famine, but we are not prepared to say that,
either sound or diseased, they breed typhus. They
have on the contrary done a world of good, for they have
been the means of expelling other epidemics which for-
merly afflicted the people in years of scarcity. I shall con-
fine myself to the mention of the raphania (ergotism),
a sort of disease under which the nervous system suf-
fered greatly, while of typhous symptoms there were none.

— 31 —

This affection was referable to the too abundant use
of blighted corn in bread and farinaceous food. Up to
1770 — 72, the years of the great famine, it here and
there made itself disagreeably prominent; since then it
became gradually rarer in proportion as the people have
grown ^ more potatoes, and the farmers have bestowed
more attention on keeping their fields clean.

The causes of scurvy are to be sought for in another
set of conditions, as in the defect or too little variety
in the aliment, and in the want of all vegetable food. It
likewise is now almost unknown in Germany where once
with every dearth it too plagued the land. It never-
theless does appear now and again in single or in
groups of cases. No longer gone than last summer,
among my first cases of spotted fever in the hospital,
there was a half famished man far gone with scurvy.
Recovering from this he was unfortunately infected with
spotted fever. The Crimean war furnished us with nu-
merous instances of scurvy as well as of war typhus,
especially among the fleet, when the difficulty of pro-
curing fresh food naturally increased the disposition to
such diseases. Typhus, however, cannot like ergotism and
scurvy be referred back to certain properties in the food,
or deficiencies in the means of nourishment It has ra-
ther invariably been the prevalent custom to believe that
several coexisting conditions and the co-operation of se-
veral noxious principles (Schadlichkeiten) are indispen-
sable in order to produce what is termed ^ cause of
typhus.'' Under the head noxious principle we class:
1) want (bad food), 2) overcrowdinffy 3) effluvia exhaled
from eacrementitial matter.

The latest English writers have recently begun to

~ 32 —

attempt an disentanglement of those noxious principles
or elements. Murchison in particular has not scru-
pled to make each of them bear on one of the three
forms of typhus. He derives relapsing-fever from scar-
city, spotted from overcrowding, and enteric from filth
— that from the common sewer. This division has some-
thing to recommend it, in as far as it brings a desirable
simplicity and clearness into our views, and affords the
memory convenient holds. Just for that reason, how-
ever, it must be accepted all the more cautiously, for in
my opinion it is only partially correct.

Beginning with scarcity, I say, I do not consider,
it sufficient in itself to produce one of those phases of
typhus. The history of human suffering has noted many
a famine year unaccompanied by typhus. I have already
repeatedly alluded to the great famine of Bengal in 1770.
After Kennedy the dearth in Ireland from 1725 — 27
was not marked by fever. In the February of 1852 I
was despatched by the Bavarian Government on a mis-
sion to the Spessart where great distress prevailed, but
nowhere did -I meet with the typhus fever. It may
perhaps be of some interest to give a few short quota-
tions from my then report.

Already had the years 1846 and 1847 brought bad
grain harvests and a consequent dearth in the Spessart,
though potatoes and fruits had turned out tolerably, while
the cold damp weather of 1851 brought on a regular
famine. ^The failure of the potatoes was so complete,
that in many places it was not considered worth the
while to lift them, and the continuous rains rendered it
impossible for many to lead in the com which moreo-
ver was barely* ripe. The hail had already damaged a

— 33 —

party as did the autumnal rains the hay, the only thing
they had to fall back on for the maintenance of their
already reduced number of cattle. The pigs, the main
resovurce of the Spessarters and their chief source of in-
come, had to be sold without delay as the potato did
not evefn promise sustenance for man." By the time I
reached the EQghlands things were looking very bad
indeed. ^The scarcity had reduced the means of live-
lihood, at aU times spare and scant, to the very mea-
gerest dimenirions. Butcher's meat, at no time a gene-
ral fare, was almost not to be seen ; butter was rare and
milk equally so. The fewest could bake bread from
their own stores, for even the buckwheat was used up.
Some had nothing but flour of which they prepared a
soup devoid both of strength and flavour. Others had
still pease, lentils or beans, the best fare under such cir-
cumstiuices, but they had been cultivated so sparingly
that they rather formed an exception than otherwise.
Many used dried and mouldy barley or in default of
that withered turnips minced up, of which a coffee-like
decoction was prepared and drunk, the grounds being
then Slaved up for their midday meal. Luckily the po-
tatoes which had been lifted diseased did not go further
in the cellar. But in many places they were only half
grown, extremely small and watery; many searched the
field painfully for the roots forgotten in harvest or left
tiiere on purpose. Comparatively abundant and there-
fore much used was cabbage (Sauerkraut) and turnips."
The distress had certainly nowhere reached such a
pitch as to cause deaths by starvation. But it must be
confessed that the above description betokens a scarcity
such as has not been exceeded in many wars notorious

3

— 34 —

for typhus epidemics, a scarcity which by its dura-
tion and extent had well produced typhus, if staryatlon.
alone could do it. What we met with amongst th6
people was however not typhus, but a peculiar condi-
tion of exhaustion, weakness, heaviness and torpidity of
the brain, mostly devoid of all feverish excitability. This
I termed the famine-state (status famelicus). A number
of the cases reminded of a mild ibrm of typhus, but
nowhere had contagion been proved; the result appears
to have justified me in my conclusions of its not being
typhus. The establishment of soup kitchens, the distri-
bution of bread, rice and food of like kind removed the
symptoms wherever they appeared.

I lay all the more stress on those observations
of mine, as the very same part of the country had on
a former occasion been desolated by the war typhus or
camp fever. When in the March of 1813 a French mili-
tary division had been collected about Aschaffenburg ha-
ving brought the spotted fever with them from Poland^
a mild form of epidemy was detected. After the battles
of the summer and autumn (Luetzen and Leipsic) the
war hospitals became more and more filled with such
cases, and now spotted fever spread over many of the
localities of the Spessart, a few straggling cases occurred
even as late in 1816 and 1817 as a sort of winding up.

To all appearances the strongest proofs of typhus
being an effect of starvation alone, are the experiences
of the Scotch doctors of the influence of a crisis in trade
on the spread of the spotted fever. So it was that after
the great commercial crisis in 1842 a sixth of the poor
throughout all Scotland was seized with fever, the middle
and higher classes being exempt. In two months there

— 35 -

were more cases of typhus than in the previous twelve
years. In Glasgow in 1843, 32,000 fell sick or 12 per
cent of the population, of which 32 per cent died. It
must be premised, that between 1838—41 the price of
corn had risen greatly, that in 1841 the crops had failed,
but the harvest of 1842 had been excellent. Here then
we have a case where with a good harvest and no scarcity
of provisions the typhus breaks out and spreads. It is
rather to be ascribed to a shortness of money preventing
the poor procuring themselves proper nourishment. What
besides marked this period, was an unprecedented in-
crease of crime. We draw from this that so close a
connexion does not subsist between dearth and disease
as might perhaps be presumed from the usual course
of things. How distress, how want arises, is no solution,
— the question is, that it does arise. Murchison says:
^'A careful study of the epidemics of spotted fever de-
monstrates a close connexion between the same and pe-
riods of distress and famine. They appear in every cli-
mate, in all seasons and in all weathers.^^

The history of the camp fever too, teaches us to
recognise the influence of want as a causative condition.
In the besieged fortresses as in the tents of the besie-
ger, disease as a rule spreads in proportion as the sup-
port is inadequate. Recently Jacquot frankly demon-
strated this of the Crimean war. He concludes his re-
marks with these striking words: "Typhus is less the
work of circumstances than of the men who influence
and determine them. It is not the result of the con-
ditions under which war is carried on, or better said,
it is not war, but the men who wage it that breed
the typhus." However among the blunders committed

— 36 —

Jacquot particularly emphasises defective nourishment,
from the fact, that the losses in the English army at
the commencement of the war, when the commissariat
was so blameworthy, were by far greater than among
the French troops ; while afterwards the proportion chan-
ged, as after great exertion the English soldiers were
better cared for.

The comparison of the various modern wars with
each other appears to me to be especially interesting
just in reference to this. The shorter wars as the
Italian of 1859, and the Bohemian of 1866 must na-
turally be excluded, for the typhus demands a certain
time to form and develop. But there can scarcely be
a greater contrast than between the great wars at the*
beginning of the century, and the Crimean war on the
one hand, and the American war of Rebellion on the
other; camp fever in its most virulent aspect raging
during the two former, while we miss it almost entirely
in the latter. After the official reports of the members
of the Medical staff of the North - American army the
spotted fever occurred only at intervals, and to a limited
extent, though the troops lay in great numbers and for
a longer time at single places, many serious febrile symp-
toms exhibiting themselves. But nowhere has any na-
tion expended so much care on the providing an army
with food and all appliances for the preservation of health
as did the American people in this war, every class in
society vying with each other in noble emulation.

Granted want alone does not produce typhus, still in
a great measure it prepares men to receive and develop
it in their system. A population reduced and weakened
by hunger offers the most favourable soil for the growth

— 37 —

of an epidemy even supposing it has been called forth
by other causes. Nor is this to be overlooked, that in
the fewest number of cases a simple withdrawal of pro«
visions takes place; it is the resorting to all manners of
substitutes, and those frequently of the very worst sort;
thus introducing noxious elements into a system unable
to offer resistance. Whether the decomposed state of those
substitutes only partially deserving the name of food, is
of force to produce typhus, I leave unanswered, as mo-
dern research has overturned many apparently incon-
trovertible facts of by-gone experience. In any case it
is undeniable, that food received in a corrupting state
is to be reckoned to one of the most preparative and
promotive causes.

But what we have termed overcrowding has an
immeasurably greater influence. It was first in the hi-
story of the prison fever that our attention was parti-
cularly directed to it. And at this moment it deserves
our special study as at present in Ostpreussen, the pri-
sons have again been pointed out as suspicious centres,
from whence typhus spreads. One of the first writers
who have called our attention to this is Lord Bacon.
He ascribes the baleful influence to the prison atmo-
sphere which is engendered when prisoners have been
shut up for any length of time in close dirty rooms. He
tells how dangerous it is; for in some instances during
the legal proceedings judges as well as a great number
of the audience were taken ill and died. Such trials
received in £ngland the significant name of the ^black
assizes.'^ A whole string of them is enumerated in the
period between 1522 — 1750. In the last year at the
Black Assizes in the Old Baily, died four of the six

— 38 —

members of the judges' bank, tbe Lord Mayor, two
judges and an Alderman, besides a large proportion of
the officers of the law.

Sir John Pringle, the recorder of this tragic re-
miniscence, accompanied the English army in 1742 — 43
to Germany, afterwards to Flanders and Brabant, as
physician - general , and there first became acquainted
with war typhus under the phase of hospital fever. He
was the first to detect and prove the identity of jail with
hospital fever and to trace both to noxious effluvia cor-
rupting the air. Since Hil den brand in his cele^^rated
work "On contagious typhus" went over to his view,
and clearly stated that "an excess of human effluvia is
alone the source of all typhous matter," it has become
general, especially for spotted fever which is for the most
part presumed to originate in this manner.

But here I must remark that this in my opinion is
a too partial view of things. A certain disproportion
of space to the number of individuals in it never fails
to deteriorate the atmosphere, it may be to such a se-
rious degree as to occasion the death of one or more
individuals; but it is by no means said, thai spotted
fever is thereby engendered, or that death is a conse-
quence of that fever. So much as for the present can
be said, is that want of proper nourishment and above
all a very high degree of uncleanliness, are among the
primary causes of spotted fever. The worse the venti-
lation and the rarer the admission of fresh air, the more
rapidly is typhus miasma formed in a confined space.

Such a confined space may be a prison cell, a dck
room, the hold of a ship or a casemate -^ the where is in-
different. Nay tbe closf) space piay be found, where as at

— 39 —

a first glance one would suppose just the very reverse. An
arnoy in the field, labourers by the roadside, the population
of a village — all such are apparently so constantly in the
open air that one must presume all the conditions present
which are requisite for the dispersion (i. e. the rendering
innocuous) of the foul miasmata floating in the atmosphere.
Nevertheless we find here a union of circumstances per-
fectly similar to those found in filthy prisons. So long as
an army is on the march I admit it is not apt to breed ty-
phus; at the most it may get it by transmission from others.
But let an army encamp or go into quarters, more espe-
cially in bad weather, when the men crowd together in
their tents or rooms, you have all the requisites for over-
crowding. Labourers on a highroad erect themselves mud
huts of the very smallest dimensions, with space for only
the occupants and their tools. Just in such mud huts, bur-
rows I should say, has spotted fever recently been bred
in Vorpommern and Ostpreussen. The more inclement
the weather is, the greater necessity for the labourers
to seek for refiige from the wet and cold in those close
damp dirty holes , and- so much the more are they ex-
posed to be seized by illness.

The same holds good of town and country dwellings.
The forf or siege fever may serve as the precedent for
such class of cases. To exemplify them we have one
only case to adduce, the circumstances of which in all
respects resemble those of a siege. In the severe winter
of 1808 — 1809, when the most piercing cold alternated
with the mildest weather, the fort Castel opposite May-
ence, in itself a close dirty place, overcrowded with a
quantity of stranger pioneers, who, the fortification works
being interrupted on account of the cold, pined with

— 40 —

their numerous families in the most abject state of mi-
sery. They housed mostly in stables, casemates, or in
barns, starving and vainly hoping from day to day
for the works to be re -opened. At length the Rhine
likewise went beyond its banks, and all the low -lying
land as far as the eye could reach was under water,
Castel with its bulwarks looking like a floating fortreea
on the great watery waste. Under these circumstances
towards end of the year 1808, the typhus fever broke
out among those unemployed hands. Rapidly it passed
to all classes leaving not a doubt of its contagions qua-
lities by its spreading in time to Hochheim, RosseU-
heim and Florisheim, all in the neighbourhood.

Every single house may at times be likened to an
overcrowded fortress. I have already adverted to the
hovels of the Irish labourers as to hotbeds of fever. Any
set of people occupying a space disproportioned to their
number incur the danger of sickening. There is the
Silesian district of Rybnick; for a course of thirteen
years the number of the inhabitants had outgrown that
of their dwellings, the proportion of increase being that
of twenty to one. It is easily intelligible that among
a rural population such a huddling together of dwellings
is productive of more evil consequences in winter than
in summer, when almost every one is at work out of
doors; whereas in the cold season the inmates are bound
to the house, every opening, as windows and doors, being
kept as close shut as possible. Such a state is naturally
aggravated under the pressure of want of work and food
and fuel, when the whole household in fact, in a state
of dull depression, are huddled together in a single room.
That is obviously one of the reasons why spotted fever

— 41 —

80 frequently breaks out in winter and in years of
&mine.

There is formed then a house, I may likewise say,
a room miasma, as in an overcrowded hold, there is
formed a ship's miasma which, however it may arise, en-
genders a ship's fever among crew and passengers. Thus
we have a limited epidemy that we may without further
scruple term a house fever or room fever. Any one
entering such a space and remaining some time in it
is exposed to the danger of falling sick, not exactly by
contagion, for he simply sickens as any one going to a
mu'shy district is exposed to catch marsh fever (inter-
mittent fever). It may likewise be carried from place
to place by means of clothes or other substances, not
that I should exactly say by contagion in the common
acceptation as from man to man.

This explains many of the contradictions relative
to its contagious qualities which are understood now in
a wider, now in a narrower signification. Thus also is
explained, be it remarked, the close connexion between
the different sorts of war fever, and the varieties of fa-
mine fever, scarcely be intelligible but for the middle
connecting links here specified.

We dare not however overlook that in all those
phases of distress the third point mentioned above comes
into prominent consideration. The corrupt nature of spoiled
provisions, the impureness of the atmosphere caused by
the effluvia from human dwellings have all been insisted
on, only the impurity or pollution arising &x>m human ex-
crement remains to be mentioned. Latterly the medi-
cal men have inclined more and more to the view that
the enteric typhus, differing in some degree from the

- 42 -

spotted may be traced back to this source. The great
strictness with which sanitary measures are enforced just
in England, the great care bestowed on keeping the pri-
vies, the sewerage and drains in a clean wholesome con-
dition, of preserving the drinking water and the water
of the rivers pure — all this is the result of the convic-
tion, that neglect of public cleanliness in towns and vil-
lages, as also in private dwelling-houses, revenges itself
at no distant period on body and life. Whether we
incline more to the supposition that noxious particles
are diJffused in the atmosphere from accumulations of
human excrement, and again received into our bodies
by means of our breathing organs, or whether we prefer
the view, that bodies in a state of decomposition pene-
trate the soil and so reach the wells and the water men
drink, in any and every case the point is to remove
the filth, before it passes over to a state of decomposi-
tion and assumes the qualities of '^typhus poison/'

How nigh the notion of the presence of real poison
is among a sickening population , and especially of its
being in the drinking water, is shown us by the con-
ceptions of the Middle Ages. At that time few epi-
demics ran their course that the suspicion of poison-
ing the well did not attach to some one; the fury of
the populace turning first against the Jews. Epide-
mics and Jewish persecutions seemed by some internal
law of necessity to go hand in hand — a sad instance
of how the human mind even in the perfectly justifiable
path of investigation can by prejudice be diverted from
the true course, and end by making the innocent suf-
fer for the guilty. Many in those otir modern days in-
cline very much to make, not the Jews, but the demo-

— 43 —

crats responsible for all the evil dow wrought in the
world! With what pleasure do we lay our own bur-
dea on the shoulders of others! No doubt the wells
were poisoned but not by single malicious individuals,
but by the general negligence. The 'criminal is not a
stranger; those who raise the hue and cry are themselves,
though unwittingly, their own worst enemies. Negli-
gence and ignorance — those are the foes that must be
combated, and every typhus epidemy should first of all
be serviceable in disseminating common sense notions
about the causes of disease, and calling upon all to pro-
mote by word and deed public and private cleanliness.
Bodily diseases should be regarded as nothing short of
crime, for its most fruitful source likewise, is as we all
know, ignorance and negligence.

When in the year 1840 the typhus broke out in
Scotland with desolating power, Alison, a clinical pro-
fessor of Edinburgh, shewed that the state of the poor
and the inadequate measures of government bore a chief
part of the blame. He further thus expressed himself
that ^the occurrence of such epidemics should be an
overpowering testimony to the law-giver of the wretched
condition of the poor.^' Corrigan, an Irish medical man
in a work published 1846, bearing the title: Famine and
fever as cause and ejSect in Ireland, dwells at more length
on the same idea. Parliament it is true had taken new
steps towards the reform of the Poor Laws, the system
of Workhouses had been extended; the famine of 1846,
however, had proved those measures to have fallen short
of the necessity. The increasing distress swelled the
numbers in the Poorhouses. The overcrowding engen-
dered the contagious epidemy which in the shortest pos-

•— 44 —

sible time turned the workhouses into hospitals, and a
mortality ensued, which weekly swept away from 3 — 400,
which number rapidly increased to 2500. ^Besides the
Poor Tax,'' says vonKleinschrod, ^government ex-
pended eight millions over and above to rescue the Irish
population in that fatal period from starvation; but si-
milar sacrifices with similarly fruitless results will be re-
peated in every future catastrophe of a similar nature, till
the industrial and agricultural relations of the nations
undergo a thorough transformation, and the majority of
the inhabitants are raised to independent producers and
thereby to that dignity of humanity which alone affords
a sure guarantee against bestial debasement and the im-
poverishing of the masses.'^

We too are now in the position of making like sa«
orifices. Let us in passing recall to mind, that in these
twenty years very moderate progress indeed has been
made in the insight how to deal with such subversions
of the masses. I believed I had done at that time all that
could be done to make the connexion between disease and
the political and social organization of the people clear. I
wrote then: ^History has more than once shown that the
destinies of great kingdoms were influenced by the sa-
mtary condition of the nation or army; and it cannot
any longer be doubted that the history of epidemic dis-
eases must form an inseparable part of the history of
human civilization. Epidemics are like gigantic finger-
posts indicating to the statesman of higher aim, such
an interruption has occurred in the development of his
people, as even a negligent cabinet dare not overlook.''
At that time I entertained greater hopes than I do
now, that statesmen of a nobler stamp would again get

— 45 —

possession of the rudder of state. But behold! Ireland
is still to this very day the land of famine fever and
emigration; and as Ostpreussen at present, so is many
another member of our native country in the helpless
condition of being by the failure of one or two harvests
reduced to a state of starvation. Unfortunately the ex-
periences of twenty years have received but too true a
confirmation by what an English medical man of stand-
ing, William Davidson, has said: ^Although our
philanthropists are exceedingly active as long as an epi*-
demy lasts, still as soon as it abates they relax in their ef-
forts, sinking into a state of comparative indifference, and
the poor into their former habits, into filth and excess.'^

How often must it be thundered forth, that typhus
is one of those diseases which in the greatest number
of cases might have been avoided. Is there any dif-
ference between it and the plague which in former cen-
turies swept over Europe in a rapid succession of epi-
demics ? And the plague has not only disappeared out
of Europe, but even out of its cradle-land Egypt, after
having made it her abode for nine centuries. It did
not use to be in Egypt either. During the times of the
last Pharaohs, the 194 years of the Persian occupaticxa,
the 305 of Alexander's and the Ptolemies', the whole
period of the Roman possession, in short so long as a
good police and a certain continuity of culture existed,
not a word was heard of the plague in Egypt. Nature
has in no way altered her ways ; ^the regular succession
of the seasons'', says Hecker , ^exists without a variation,
ever since the Nile first precipitated itself from the Abys-
sinian mountains into the plain below. But", he goes on
to say, ^the Egypt of to-day is no longer the splendid

— 46 —

country of the Pharaohs and Ptolemies, famed for her
fertility and the health of her children. It is ruled by
avaricious and cruel barbarians. Slavery and brute force
which succumb to the elements, have taken the place
of the intelligent practice of art and of persevering in-
dustry that could sway nature.'^

It is about thirty years ago since this was written.
Since then the plague has ceased to be the standing
scourge of that country, while on the other hand there
are no corresponding changes in nature or the weather to
serve as an explanation. A species of national govern-
ment has been established which has even made some ap-
proaches to a constitutional form — a government which
has at least shown it comprehends that the well being
of a people is a necessary condition to a healthy finan-
cial condition; for if your farmer has to pay high taxes,
why then he must be enabled to do so. Agriculture is
improving, the canals repairing, nay the steam -carriage
rolls along its iron path to the very foot of the pyra-
mids. It is the new-born civilization that has driven
the plague from her old haunts.

When in the year 1848 I published my pamphlet
on the typhus in Silesia, this happy turn in affairs had
not yet become a matter of undoubted fact. I neverthe-
^less considered myself justified in drawing the following
conclusions on typhus fever &om the ancient history of
the pfague. ^The logical answer to the question, how
to obviate similar catastrophes as we had in Silesia is
simple and easy — higher culture, greater liberty and
prosperity! Do we cot see every where around us, that
national diseases allow of being traced back to defects
in our social system? Let them talk as much as. they

— 47 —

will about this or that yariatioa in the weather, about
grand cosmical changes along with phraees of a like
description -^ all those causes can never of themselves
produce an epidemy, but they can foster it, when by rea-
son of mischievous social arrangements men have for a
longer or shorter time lived in an abnormal state/'

Famine fever, however^ possesses this advantage over
her compeers, more particularly camp fever or war ty-
phus — to express myself more generally — viz. it be-
longs in a higher degree to the avoidable diseases. The
vicissitudes of war may at times embarras the very
best military administration, rendering it impossible for
them to feed, quarter and do for an army with such
forethought as to ward off all danger of sickness. But
a district or a province which falls a prey to famine
fever is only paying with pestilence for a long series of
blunders. How many of those blunders the victims and
the sufferers have themselves committed, how many the
authorities, must be judged separately in every separate
case. But as we have already proved, carelessness and
ignorance are at bottom somewhere, else timely and ade-
quate measures must have been taken either by the
people or the authorities. However lasting assistance
for the future is alone possible, when thoughtful and
selfacting men voluntarily combine in sufficient numbers
to set on foot general sanitary measures in every parish
and district* —

Let us hope that this so dearly bought experience
will not be lost upon us, or as so often before, be rendered
fatile. May this season of heavy trial we are now called
on to pass through impress our people with the lasting
consciousness that they dare not weary in the labour

— 48 —

of peace^ without which liberty and culture — the two
stipulations for the general welfiEure and prosperity —
cannot be made ours I A {eunine fever is a penalty which
the people have incurred themselves through negligence
and ignorance.

Julius Sittenfeld, printer, Berlin.

». .»

"■»

4

*•

Y^